Bobby Ramakant - CNS
We are, perhaps, more likely to use a single product to simultaneously protect ourselves against unintended pregnancies and a wide range of sexually transmitted
infections (STIs) including HIV than to use different products to meet our
specific needs. Multipurpose Prevention Technologies (MPTs) have been
around for many years such as male and female condoms although their
poor utilization has been of deep concern. There is a growing mandate
globally to push for more investment in research and development of new,
safe and effective MPTs. This makes more sense in terms of public
health and getting most value of every dollar spent.

At Women Deliver 2013, there was a clear call for greater investment and political will to accelerate research and development, and eventual introduction and optimal utilization, of new MPTs.

Worldwide, women are five times more likely to get sexually transmitted infections (STIs) than men. Each day about 500,000 young people, mostly women, contract STIs. Dr Nomita Chandhiok from Indian Council of Medical Research (ICMR) was a keynote speaker at a Women Deliver 2013 session on MPTs that was supported by the Coalition Advancing Multipurpose Innovations(CAMI) and partners. Dr Chandhiok said that healthy timing and spacing of healthy pregnancies is still a challenge for many women in different parts of India. 16 million adolescent girls give birth each year and 3 million unsafe abortions take place. Dr Chandhiok said that despite significant focus on preventing unintended pregnancies and STIs over the past years, still we deal with 222 million women with unmet family planning needs in developing countries, translating into 63 million unintended pregnancies, 23 million abortions and 530,000 newborn deaths. 40% of unsafe abortions are in adolescents and youth.

Dr Chandhiok said that not just unintended pregnancies and HIV are a challenge for women and girls but also non-HIV STIs continue to adversely impact lives of women and girls and have received very little attention and response. 2,400 young people get infected with HIV every day and 2.7 million young people get infected with HIV every year. 1.8 million women die of AIDS every year. 315 million women get infected with genital herpes (once a person is infected with genital herpes it is likely to stay throughout). Very large numbers of women are living with human papilloma virus (HPV) – it is estimated that 500 million women are living with HPV with 85% deaths related to cervical cancer occurring in developing countries, said Dr Chandhiok. According to WHO data, there were 10.6 million cases of syphilis in 2008.

We will achieve greater efficiency in terms of costs, access and delivery of sexual and reproductive health services with MPTs. The high demand in the populations can also be capitalized to reduce price. However utilization of existing MPTs has been far from satisfactory. Consistent use, availability, affordability and accessibility remain a challenge with female condoms. Despite strong thrust in government programmes on male condoms, its uptake remains low: about 5% in India and 7.4% in Malaysia. Consistent use of male and female condoms is optimal but very difficult to achieve, said Dr Chandhiok.

Dr Judy Manning of USAID who is one of the key advocates of MPTs said that there are two priority areas in terms of product delivery forms. We will like to see products that can be used on demand (to be used at the time of intercourse by women) - this can be used by women who have infrequent sex or those who really want to control the use of protection. On another end of the spectrum in terms of product delivery are products with sustained release – which will do well with adherence because we will not have user dynamics or multitask and so it can increase effectiveness.

Dr Manning added that our vision is that we can develop and introduce safe, effective and acceptable MPTs that are appropriate for use especially in low resource settings.

Dr Zeda Rosenberg, IPM

Dr Zeda Rosenberg, a noted advocate of gender justice with International Partnership for Microbicides (IPM), said that promising MPTs include a single sized diaphragm and
easier to use vaginal rings that would provide contraception plus
protection against STIs. Effective, affordable and widely available MPTs
would save lives and money and improve the health of women and their
families, said Dr Rosenberg.

She added that dapivirine ring was the first study that showed that ring can release the drug where we need it. IPM is doing a study with partners to develop a ring to provide both HIV protection and contraception in a single product. IPM027 study is ongoing with a safety and efficacy study with 1,650 participants in Africa (2012-2015). Another study, formally called MTN020 or ASPIRE study is also a safety and efficacy study with 3,476 participants in Africa (2012-2014).

Georgina Caswell of Global Network of People living with HIV (GNP+) said that women living with HIV are women first. Having HIV does not mean that women living with HIV will not have other sexual and reproductive healthcare needs anymore. She strongly advocated for sexual and reproductive health and rights of women living with HIV. MPTs will provide greater choices for women with undetectable HIV viral loads who want to conceive and become pregnant, said Georgina. MPTs will also increase options for women living with HIV to have normal deliveries - there are questions now if all women living with HIV have to have caesarean, said Georgina. MPTs may also provide more options around breastfeeding for women living with HIV. She also said that there is a high level of stigma and discrimination which women living with HIV face while accessing maternal and child health (MCH) services. MPTs may potentially help reduce stigma and discrimination, said Georgina.

Access is a major challenge in most communities unintended pregnancies and STIs continue to be a daunting challenge. Low utilization of existing methods, either single-purpose or multipurpose, have a lot of lessons that must inform the future scale-up and roll-out of SRHR services, we believe. MPTs have more potential for a better utilization and public health impact because of the advantage of multiple sexual and reproductive healthcare needs they might be meeting simultaneously.